Crafting the New Treatment Mix in CLL: Pharmacist Insights on Delivering Effective Care With Targeted Therapy
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Chair and Moderator, Emily K. Dotson, PharmD, BCOP, Peter Campbell, PharmD, MBA, BCOP, and Sarah E. Stump, PharmD, BCPS, BCOP, prepared useful Practice Aids pertaining to chronic lymphocytic leukemia for this CME/MOC/CPE/IPCE activity titled “Crafting the New Treatment Mix in CLL: Pharmacist Insights on Delivering Effective Care With Targeted Therapy.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/CPE/IPCE information, and to apply for credit, please visit us at https://bit.ly/3ZdXwAM. CME/MOC/CPE/IPCE credit will be available until April 29, 2024.
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Crafting the New Treatment Mix in CLL: Pharmacist Insights on Delivering Effective Care With Targeted Therapy
- 1. Ibrutinib1 Acalabrutinib Maleate Salt2 Zanubrutinib4 Moderate CYP3A Inhibitors Reduce ibrutinib dose to 280 mg once daily Reduce acalabrutinib dose to 100 mg once daily Reduce zanubrutinib dose to 80 mg twice daily Dosage Forms Capsules Tablets (IR film-coated tablet; capsule formulation has been discontinued)3 Capsules Gastric Acid– Reducing Agents No dosage adjustment recommended Tablets can be used regardless of use of PPIs and ingestion of food No dosage adjustment recommended Standard Dose 420 mg once daily 100 mg every 12 hours 160 mg twice daily or 320 mg once daily Moderate or Strong CYP3A Inducers Avoid use Avoid use; if necessary, increase acalabrutinib dose to 200 mg twice daily Avoid use Strong CYP3A Inhibitors Reduce ibrutinib dose to 140 mg once daily; for short-term use, consider interrupting ibrutinib Avoid use Reduce zanubrutinib dose to 80 mg once daily Safety Monitoring Monitor for atrial fibrillation, infections, bleeding, cytopenias, and TLS Monitor for atrial fibrillation, infections, bleeding, and cytopenias Monitor for arrhythmias, infections, bleeding, and cytopenias Pirtobrutinib5 Avoid use; if use is unavoidable, reduce the pirtobrutinib dose to 50 mg Tablets No dosage adjustment recommended 200 mg once daily is approved for MCL and is in phase 3 testing in CLL/SLL Avoid use; if use is unavoidable, increase the pirtobrutinib dose Avoid use; if use is unavoidable, reduce the pirtobrutinib dose to 50 mg Monitor for arrhythmias, infections, bleeding, and cytopenias Covalent BTK Inhibitors Non-covalent BTK Inhibitor (Listing Is Based on Approved MCL Labelling) Dosing, Drug–Drug Interactions, and Safety Monitoring With BTK Inhibitors in CLL/SLL Full abbreviations, accreditation, and disclosure information available at PeerView.com/XPM40 1. Imbruvica (ibrutinib) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/205552s002lbl.pdf. 2. Calquence (acalabrutinib) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/210259s000lbl.pdf. 3. Sharma S et al. ASH 2021. Abstract 4365. 4. Zanubrutinib prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/213217s007lbl.pdf. 5. Jaypirca (pirtobrutinib) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/216059Orig1s000Corrected_lbl.pdf.
- 2. Venetoclax1 standard dose in CLL/SLL • 400 mg once daily with ramp-up dosing to target dose by week 5 • Tablets: 10 mg, 50 mg, and 100 mg Strong CYP3A Inhibitors Moderate CYP3A Inhibitors P-gp Inhibitors Moderate or Strong CYP3A Inducers Safety Warnings Contraindicated during initiation and ramp-up phase and avoid use during all phases; if use is unavoidable, reduce venetoclax dose by at least 75% Avoid use; if use is unavoidable, reduce venetoclax dose by at least 50% Avoid use; if use is unavoidable, reduce venetoclax dose by at least 50% Avoid use • Anticipate for TLS: premedicate with antihyperuricemics and ensure adequate hydration • Monitor for neutropenia: check blood counts and for signs of infection • Do not administer live attenuated vaccines prior to, during, or after treatment Ramp-Up Dosing Schedule WEEK 1 20 mg Once daily WEEK 2 50 mg Once daily WEEK 3 100 mg Once daily WEEK 4 200 mg Once daily Dosing, Drug–Drug Interactions, and Safety Monitoring With Venetoclax in CLL/SLL Full abbreviations, accreditation, and disclosure information available at PeerView.com/XPM40 1. Venclexta (venetoclax). Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/208573s000lbl.pdf.